Healthcare Provider Details

I. General information

NPI: 1114008679
Provider Name (Legal Business Name): LAWRENCE THOMAS WEIR DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 10/02/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 WAPPOO CREEK DR SUITE 5
CHARLESTON SC
29412-2136
US

IV. Provider business mailing address

113 WAPPOO CREEK DR SUITE 5
CHARLESTON SC
29412-2136
US

V. Phone/Fax

Practice location:
  • Phone: 843-762-1234
  • Fax: 843-762-9142
Mailing address:
  • Phone: 843-762-1234
  • Fax: 843-762-9142

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2971
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: